The Canadian Morphea Registry: Design, Baseline Characteristics, and Age-Related Differences in a National Multicenter Cohort

BACKGROUND: Morphea is a rare immune-mediated fibrosing skin disorder with heterogeneous clinical manifestations across the lifespan. Existing large cohorts have predominantly originated from the United States and Europe, while national Canadian data spanning pediatric and adult disease are lacking. OBJECTIVE: To characterize morphea across the lifespan in a national Canadian cohort, with particular emphasis on age-related differences in clinical phenotype, diagnostic pathways, disease burden, and treatment patterns. METHODS: The Canadian Morphea Registry (C-MORE) is an ongoing prospective, multicenter observational registry of pediatric and adult patients with morphea and eosinophilic fasciitis. Baseline demographic, clinical, treatment, and patient-reported outcome data accrued from June 2021 through August 2025 were analyzed and compared by age group and against established international registries. RESULTS: Among 213 patients enrolled across 9 academic centers, 68.5% were adults; 31.5% were children. Linear morphea predominated in children (49.2%) and generalized morphea in adults (31.3%). The mean diagnostic delay was 1.9 years, and 27.2% reported prior misdiagnosis, most commonly eczema. Adults had higher baseline disease activity, whereas children carried greater cumulative damage, including among those classified as inactive. Systemic therapy was more common in children (61.0%) than adults (39.1%); methotrexate was most frequently prescribed. CONCLUSION: C-MORE provides the first national Canadian characterization of pediatric and adult morphea within a publicly funded healthcare system. Marked age-related differences in phenotype, disease activity, accumulated damage, and treatment were observed, while diagnostic delay and frequent prior misdiagnosis remained important across age groups. Longitudinal follow-up will determine how these differences influence disease trajectories and treatment outcomes.

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Journal
Journal of Cutaneous Medicine and Surgery
Published
2026-11-01
DOI
https://doi.org/10.1177/12034754261490572
Primary Topic
Systemic Sclerosis and Related Diseases
Type
article
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article

The Canadian Morphea Registry: Design, Baseline Characteristics, and Age-Related Differences in a National Multicenter Cohort

Lyne Bissonnette, Elena Netchiporouk, Gaëlle Chédeville, Michelle Batthish et al.
Journal of Cutaneous Medicine and Surgery
Systemic Sclerosis and Related Diseases
article

The Canadian Morphea Registry: Design, Baseline Characteristics, and Age-Related Differences in a National Multicenter Cohort

Lyne Bissonnette, Elena Netchiporouk, Gaëlle Chédeville, Michelle Batthish, Stephanie Ghazal, Alexandra Mereniuk, Kevin Pehr, Anastasiya Muntyanu, Maxine Joly-Chevrier, Jan Peter Dutz, Dax G. Rumsey, Cathryn J. Sibbald, Catherine Cameron McCuaig, Carmen Liy‐Wong, Catherine Keying Zhu, Mehul Jariwala, Maryam Piram, Nadia J. C. Luca, Elena Pope, Mylène Veilleux, Marie-Claude Dionne, Ronald M. Laxer, Jean‐Philippe Proulx‐Gauthier, Alessandra Bruns, Joanie Pinard, Orhan Yilmaz, Meng Li, Xin Yu, Allison Gregory, Alexandra Carla Bobica, Jessica Muha, Mohamed Osman, Emma Rispler, on behalf of the Canadian Morphea Registry (C-MORE) Investigators
article en

Abstract

BACKGROUND: Morphea is a rare immune-mediated fibrosing skin disorder with heterogeneous clinical manifestations across the lifespan. Existing large cohorts have predominantly originated from the United States and Europe, while national Canadian data spanning pediatric and adult disease are lacking. OBJECTIVE: To characterize morphea across the lifespan in a national Canadian cohort, with particular emphasis on age-related differences in clinical phenotype, diagnostic pathways, disease burden, and treatment patterns. METHODS: The Canadian Morphea Registry (C-MORE) is an ongoing prospective, multicenter observational registry of pediatric and adult patients with morphea and eosinophilic fasciitis. Baseline demographic, clinical, treatment, and patient-reported outcome data accrued from June 2021 through August 2025 were analyzed and compared by age group and against established international registries. RESULTS: Among 213 patients enrolled across 9 academic centers, 68.5% were adults; 31.5% were children. Linear morphea predominated in children (49.2%) and generalized morphea in adults (31.3%). The mean diagnostic delay was 1.9 years, and 27.2% reported prior misdiagnosis, most commonly eczema. Adults had higher baseline disease activity, whereas children carried greater cumulative damage, including among those classified as inactive. Systemic therapy was more common in children (61.0%) than adults (39.1%); methotrexate was most frequently prescribed. CONCLUSION: C-MORE provides the first national Canadian characterization of pediatric and adult morphea within a publicly funded healthcare system. Marked age-related differences in phenotype, disease activity, accumulated damage, and treatment were observed, while diagnostic delay and frequent prior misdiagnosis remained important across age groups. Longitudinal follow-up will determine how these differences influence disease trajectories and treatment outcomes.

Journal of Cutaneous Medicine and Surgery
St. Michael's Hospital (CA), Université de Sherbrooke (CA), University of British Columbia (CA), University of Alberta (CA), University of Toronto (CA), Children's Hospital of Eastern Ontario (CA), Hospital for Sick Children (CA), McGill University Health Centre (CA), Jewish General Hospital (CA), Centre Hospitalier Universitaire Sainte-Justine (CA), University of Saskatchewan (CA), Hôpital du Sacré-Cœur de Montréal (CA), CHU de Québec-Université Laval (CA), Lady Davis Institute for Medical Research (CA), McGill University (CA), Université de Montréal (CA), McMaster University (CA)
Openalex Percentile: Top 12%
Systemic Sclerosis and Related Diseases
DOISourceOpenAlex
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